Between NSAIDs, Local Anesthetics, and Non-medicinal Analgesics, Which Method is the Most Effective at Providing Pain Relief During IUD Insertions for Nulliparous and Multiparous Women?

Objective: One major barrier for usage of intrauterine devices (IUD) includes a widespread sense of fear regarding pain during insertion of this contraception. By researching the most effective IUD insertion analgesics available and standardizing these pain management methods, women may be less fearful of obtaining IUDs. Methods: A comprehensive literature review was conducted using Scopus, PubMed, Web of Science, EMBASE and Cochrane Library to compare methods of pain relief during IUD insertions. Outcomes measured include the pain management method used, the dosage administered, the pain experienced by patients evaluated using a Visual Analog Scale (VAS) prior to insertion of the tenaculum and post insertion of the IUD. Results: Results relating to lidocaine analgesics showed inconsistent efficacies. Particularly, the use of lidocaine-prilocaine cream was evaluated to be the most substantial in lowering IUD insertion pain, followed by paracervical lidocaine, as evaluated by a holistic meta-analysis assessing 38 randomized controlled trials. The effectiveness of NSAIDs, including naproxen, diclofenac potassium and ibuprofen, demonstrated diverse outcomes in this review. While ibuprofen failed to achieve a statistically significant reduction of pain during IUD insertion, tramadol demonstrated a substantial analgesic effect compared to naproxen and placebo group. Inhaled lavender, verbal analgesics and the use of a cold compress did not produce a notable reduction in pain scores. The use of transabdominal ultrasound guidance during IUD insertion demonstrated a significant decrease in VAS pain perception compared to the traditional insertion method. Conclusions: These results emphasize the potential of lidocaine-prilocaine cream and specific NSAIDs for pain management, while also stressing the need for further research to optimize administration methods, dosages, and combinations for improved pain reduction during the procedure.